Heart Transplant
Medical Author: Michael C. Fishbein, MD
Medical Editor: Jay W. Marks, MD
Introduction to heart transplant
The idea of replacing a bad organ with a good one has been documented in
ancient mythology. The first real organ transplants were probably skin grafts
that may have been done in India as early as the second century B.C. The first
heart transplant in any animal is credited to Vladimer Demikhov. Working in
Moscow in 1946, Demikhov switched the hearts between two dogs. The dogs survived
the surgery. The first heart transplant in human beings was done in South Africa
in 1967 by Dr. Christiaan Barnard; the patient only lived 18 days. Most of the
research that led to successful heart transplantation took place in the
United States at Stanford University under the leadership of Dr. Norman Shumway.
Once Stanford started reporting better results, other centers started doing
heart transplants. However, successful transplantation of a human heart was
not ready for widespread clinical application until medications were developed
to prevent the recipient from "rejecting" the donor heart. This happened in 1983
when the Food and Drug Administration (FDA) approved a drug called
cyclosporine (Gengraf,
Neoral).
Before the advent of cyclosporine, overall results of heart transplant were
not very good.
What is a heart transplant?
Believe it or not, heart transplantation is a relatively simple operation for
a cardiac surgeon. In fact, the procedure actually consists of three operations.
The
first operation is harvesting the heart from the donor. The donor is usually an
unfortunate person who has suffered irreversible brain injury, called "brain
death". Very often these are patients who have had major trauma to the head, for
example, in an automobile accident. The victim's organs, other than the brain,
are working well with the help of medications and other "life support" that may
include a respirator or other devices. A team of physicians, nurses, and
technicians goes to the hospital of the donor to remove donated organs once
brain death of the donor has been determined. The removed organs are transported
on ice to keep them alive until they can be implanted. For the heart, this is
optimally less than six hours. So, the organs are often flown by airplane or
helicopter to the recipient's hospital.
The second operation is removing the recipient's damaged heart.
Removing the damaged heart may be very easy or very difficult, depending on
whether the recipient has had previous heart surgery (as
is often the case). If there has been previous surgery, cutting through the scar
tissue may prolong and complicate removal of the heart.
The third operation is
probably the easiest; the implantation of the donor heart. Today, this operation
basically involves the creation of only five lines of stitches, or "anastomoses".
These suture lines connect the large blood vessels entering and leaving the
heart. Remarkably, if there are no complications, most patients who have had a
heart transplant are home about one week after the surgery. The generosity of
donors and their families makes organ transplant possible.
Next: Who needs a heart transplant? »
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